Changing a Common Belief About Brain Injury

As a scientist, I am impassioned to share research findings that upend conventionally-held wisdom about the brain - modifying viewpoints that are obsolete, wrong, and disabling.

The journal Neuropsychological Rehabilitation has just published the results of a study conducted by our interdisciplinary team of experts at the Center for BrainHealth at The University of Texas at Dallas. The study found that strategy-based cognitive training significantly improves the cognitive performance, psychological and neural health of those who have experienced a traumatic brain injury (TBI), long after the initial injury.

These findings should permanently put to rest the view, once commonly held among scientists and the medical community, that the brain can only recover lost functions for a period of one year following injury. Unfortunately, insurance companies still base their coverage policies on this outdated assumption. What's worse, many of those afflicted with TBI may be tempted to give up on their recovery based on what we now know to be false.

The latest findings are sure to bring much-needed hope to the 5.3 million Americans living with TBI and their family members. TBI continues to be a leading cause of death and disability, and is a particular risk for our service members; more than 327,000 have been diagnosed with TBI since 2000. Whether caused by the blast of a bomb, or sustained in a car accident, a fall, or playing sports, such injuries--even those considered mild--can have consequences that last an entire lifetime.

Those who have sustained traumatic brain injuries often experience persistent cognitive difficulties, including poor ability to focus on the task at hand, to make decisions, or to anticipate consequences. They may feel overwhelmed or paralyzed when faced with too much information or the need to generate solutions to problems. They may also suffer from psychological difficulties, such as depression and post-traumatic stress disorder, which further hinder their participation in and enjoyment of daily activities.

Fortunately, as our study and other research reveals, the brain--even an injured brain--has tremendous power to grow, change, rewire and repair itself throughout life. We are also learning the rewiring of a brain depends on the degree to which it is challenged. If a person with a brain injury is trained using predominantly low-level thinking tasks, those are the connections that will be rebuilt.

Until now, most TBI treatment protocols have focused on restoring basic mental functions, such as memory or attention. The belief has been training should occur from the bottom up to help those with TBI rebuild their skills and mental capacity. Typically these training regimens ignore higher level thinking skills controlled by frontal lobe networks, such as decision-making, planning and judgment.

Through this study, we sought to test the hypothesis that a strategy-based cognitive training regimen focusing on higher-level thinking skills would be a more effective way to repair the brain after injury than a training that taught important facts about the brain and how it operates. Using a program we developed that focuses on improving higher-level thinking skills, we set out to determine whether this training could improve brain health and cognitive function in adults with TBI. Specifically, we wanted to find out if the training could help an individual make gains toward achieving his or her personal best.

We examined 60 individuals, both veterans and civilians, between the ages of 19 and 65 who had sustained one or more traumatic brain injuries. More than two-thirds of study participants were injured a decade or more ago, well beyond the one-year period previously thought to be the limit of brain recovery.

Study participants who received strategy-based cognitive training saw significant improvement in memory and the ability to think abstractly. They reported a 60% reduction in depressive symptoms as well as an almost 40% reduction in symptoms related to post traumatic stress disorder. Blood flow to the frontal lobe region of the brain--the area responsible for memory, attention, decision-making and problem-solving--also increased significantly following the strategy-based training. And participants continued to realize cognitive, psychological and brain blood flow benefits three to four months after training, suggesting their health continued to improve even after the training ended.

The implications of these research findings are enormous. No longer can we falsely assume that brain injury survivors can recover only for a certain period or that they are destined to regain only a limited number of skills. The potential for improvement is far greater than previously believed possible. With the right interventions, TBI survivors can continue to make progress repairing their brain's health and their lives for many years. That knowledge should significantly change the way we think about--and address--this enormous public health challenge.